Nursing Elites

1. A nurse in an emergency department is assessing a client who reports ingesting thirty diazepam tablets and has a respiratory rate of 10/min. After securing the client's airway and initiating an IV, which of the following actions should the nurse do next?

• A. Monitor the client's IV site for thrombophlebitis
• B. Administer flumazenil to the client
• C. Evaluate the client for further suicidal behavior
• D. Initiate seizure precautions for the client

Correct answer: B

Rationale: Administering flumazenil is the priority to reverse the effects of diazepam overdose. Monitoring the IV site for thrombophlebitis (choice A) is important but not the next immediate action. Evaluating the client for further suicidal behavior (choice C) is important but not the priority at this moment. Initiating seizure precautions (choice D) is not the priority action in this scenario.

2. A client has a new prescription for hydrochlorothiazide. Which of the following instructions should the nurse include?

• A. Take this medication at bedtime to prevent dizziness.
• B. Increase your intake of potassium-rich foods.
• C. Take this medication with food to prevent gastrointestinal upset.
• D. This medication can increase your blood pressure.

Correct answer: B

Rationale: The correct instruction that the nurse should include for a client prescribed hydrochlorothiazide is to increase their intake of potassium-rich foods. Hydrochlorothiazide is a diuretic that can lead to potassium depletion, so increasing potassium-rich foods helps prevent hypokalemia. Option A is incorrect because hydrochlorothiazide is usually taken in the morning to prevent diuresis at night. Option C is not necessary as hydrochlorothiazide can be taken with or without food. Option D is incorrect because hydrochlorothiazide is used to lower blood pressure, not increase it.

3. What is the best method to assess pain in a non-verbal patient?

• A. Observe for facial expressions
• B. Observe for restlessness
• C. Observe for sweating
• D. Check for non-verbal cues

Correct answer: A

Rationale: The correct answer is to observe for facial expressions when assessing pain in a non-verbal patient. Facial expressions can provide vital clues about the patient's pain level and discomfort. Choices B and C, observing for restlessness and sweating, can be less specific and may indicate other issues besides pain. Choice D, checking for non-verbal cues, is too broad and does not specify the crucial aspect of focusing on facial expressions.

4. A client with acute diverticulitis should have which intervention included in the care plan?

• A. Administer a cleansing enema.
• B. Initiate a low-fiber diet.
• C. Apply moist heat to the abdomen.
• D. Provide a clear liquid diet.

Correct answer: B

Rationale: The correct intervention for a client with acute diverticulitis is to initiate a low-fiber diet. A low-fiber diet helps manage acute diverticulitis by reducing irritation to the colon, allowing it to heal. Administering a cleansing enema (Choice A) can worsen diverticulitis by increasing pressure within the colon. Applying moist heat to the abdomen (Choice C) may provide comfort but does not address the underlying cause. Providing a clear liquid diet (Choice D) is not ideal for diverticulitis management as it lacks the necessary nutrients for healing and may not provide enough bulk to prevent further irritation.

5. How should a healthcare provider handle a patient with non-compliance to hypertension medication?

• A. Provide education about medication
• B. Refer the patient to a specialist
• C. Explore alternative treatments
• D. Reassess the patient in 6 months

Correct answer: A

Rationale: Providing education about the importance of medication adherence is crucial in managing hypertension. By educating the patient about the significance of taking their medication as prescribed, the healthcare provider can help improve compliance and control the patient's blood pressure. Referring the patient to a specialist (Choice B) may be necessary in some cases but addressing non-compliance should start with education. Exploring alternative treatments (Choice C) could be considered if the current medication is not suitable, but initial steps should focus on improving adherence. Reassessing the patient in 6 months (Choice D) may be too delayed if non-compliance is an issue that needs immediate attention.

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